Published on JAMA Network, July 17, 2018
Prevalence of attention-deficit/hyperactivity disorder (ADHD) in youth, with a worrisome 7% affected, and the potential increase in rates in some populations.
Could digital media, like social media and streaming, might be connected to symptoms of attention-deficit/hyperactivity disorder (ADHD) in teenagers?
The study aims to examine the association between modern digital media use frequency among 15- and 16-year-olds without significant ADHD symptoms and subsequent ADHD symptom occurrence over a 24-month follow-up period.
Who were the Participants of this Study?
The study utilized data from the Happiness & Health Study, which is a longitudinal cohort survey of adolescents in Los Angeles. Ten public high schools were selected from 40 approached schools based on their interest in participating, demographic composition, and proximity. The variables were measured in the fall of 10th grade as the baseline survey. The sample included students without ADHD symptoms at baseline, and data were analyzed at various follow-ups over 24 months from fall 2014 to fall 2016.
How were the ADHD Symptoms measured?
Using Current Symptoms Self-Report Form 6 measure to assess ADHD symptom criteria based on the Diagnostic and Statistical Manual of Mental Disorders-4th Edition (DSM-IV). This included 9 inattention symptoms and 9 hyperactivity-impulsivity symptoms rated on a scale of frequency for the preceding 6 months. Adolescents reporting 6 or more symptoms in either category were classified as having ADHD symptoms.
Self-assessment of ADHD symptoms compared to clinical interviews showed a diagnostic sensitivity of 79% and a specificity of 60%. The ADHD symptom severity score was derived from the sum of the symptom frequency ratings and showed concordance with clinician-derived severity scores. The study also examined digital media use, with participants reporting their engagement in 14 media activities. The responses were dichotomized into high-frequency and other frequency levels, and a cumulative media-use index ranging from 0 to 14 was calculated.
What did the Researchers find out?
💠The study included 2843 students, of whom 97.7% provided ADHD symptom data for at least one follow-up, forming the analytic sample for the secondary outcome.
💠Majority of students (80.9%) reporting high-frequency use of at least 1 activity.
💠A small percentage of students experienced ADHD symptoms at various intervals between surveys
| Survey Intervals | ADHD Symptom Prevalence (%) |
| 6 months | 6.9 |
| 12 months | 4.8 |
| 18 months | 5.7 |
| 24 months | 5.9 |
💠More symptoms were present when frequency of digital usage was as compared to the baseline.
| Frequency of digital activities | ADHD Symptom Prevalence (%) |
| No high frequency | 4.6 |
| 7 high-frequency activities | 9.5 |
| 14 high- frequency activities | 10.5 |
💠The study found a relationship between higher digital media use and increase in symptoms of ADHD over a 24-month follow-up period, with an odds ratio of 1.11 per additional digital media activity.
💠 Race/ethnicity, self-reported delinquent behavior, depressive symptoms, substance use, and family substance-use history to account for potential confounding factors.
💠The study found statistically significant associations between media-use index and ADHD symptom status at all time points.
💠The primary analysis revealed that higher baseline high-frequency digital media activity was significantly associated with increased odds of positive ADHD symptom occurrence during 6-month intervals, according to unadjusted logistic regression models.
💠Prevalence of ADHD symptoms did not significantly change over time and was not linked to media use.
💠After adjusting for covariates, the association between digital media use and ADHD symptom status remained significant.
💠Boys, adolescents with more depressive symptoms, and those with delinquent behaviors were also found to be at greater odds of experiencing ADHD symptoms.
💠 Repeated measures linear regression models revealed that each additional baseline high-frequency digital media activity used was associated with a 0.10 to 0.11 points increase on the ADHD symptom severity score across follow-ups, even after covariate adjustment.
💠 The sensitivity analyses conducted in the research paper focused on various factors such as missing data, baseline subclinical ADHD symptoms, and bidirectional associations between media use and ADHD symptoms.
💠 The analyses revealed significant associations between digital media use and subsequent ADHD symptoms, regardless of the approach taken in handling missing data or adjusting for baseline subclinical ADHD symptoms.
💠Importantly, the analyses did not find that the differences in reliability between digital media use and ADHD measures could explain their association over time. These findings suggest a consistent and robust relationship between digital media use and ADHD symptoms, while also providing initial validation for the measure of digital media use.
Discussion
- The observed association could be non-causal and influenced by sensation seeking or undiagnosed ADHD.
- Shared genetic or environmental factors were also considered as potential explanations.
- The study suggested that modern digital media use may disrupt attention, organization, sustained attention, impulse control, and patience, potentially contributing to ADHD symptoms.
- The change in ADHD symptoms associated with media exposure was modest, and the implications for public health and clinical practice were uncertain.
References
Chaelin, K., et al. “Association of Digital Media Use With Subsequent Symptoms of Attention-Deficit/Hyperactivity Disorder Among Adolescents.” JAMA, vol. 320, no. 3, July 2018, p. 255, doi:10.1001/jama.2018.8931.
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